Communication Disparity Between the Bereaved and Others: What Hurts Them and What Is Unhelpful? A Nationwide Study of the Cancer Bereaved

Process evaluation of a self-compassion-based online group psychotherapy programme for bereavement-related grief: a thematic analysis of the COMPACT feasibility trial

BACKGROUND

Bereavement-related grief and prolonged grief disorders are highly prevalent; however, standardised care approaches are lacking. To address this gap, the self-COMPAssion-based online group psyChoTherapy for bereavement-related grief (COMPACT) feasibility trial was developed; it showed promising participant engagement and potential effectiveness. This study aimed to elucidate the mechanisms underlying the impact, contextual factors, and implementation considerations of the COMPACT programme.

METHODS

Online semi-structured interviews were conducted and analysed using a deductive reflexive thematic analysis guided by the UK Medical Research Council process evaluation framework. The interviews involved 21 participants and 10 intervention personnel from the COMPACT feasibility trial. The Helpful Aspects of Therapy Form (HATF) was used to guide the interviews, ensuring a focus on identifying mechanisms of impact, contextual factors, and implementation considerations.

RESULTS

Four main "mechanism of impact" themes were identified: common humanity and self-awareness, perceived importance of self-care, deepening self-insights and personal growth, and amplified self-compassion. Two associated "contextual factor" themes (group therapy and a secure programme environment) were highlighted. Additionally, two "implementation consideration" themes (barriers and facilitators) were found, with related contextual themes of group therapy and online delivery.

CONCLUSIONS

The core impact mechanisms of the COMPACT programme included accessible online delivery, group work enhancing common humanity, and a safe, supportive environment deepening self-insight, self-care, and self-compassion. Future research should prioritise refining programme content, improving participant assessment, and enhancing training for intervention personnel to enable a randomised controlled trial testing the effectiveness of the intervention.

TRIAL REGISTRATION

UMIN000048554, registered 2nd August 2022.

Depression and complicated grief in bereaved caregivers in cardiovascular diseases: prevalence and determinants

OBJECTIVES

Despite the recommendation that patients with cardiovascular disease (CVD) receive bereavement care, few studies have examined the psychological disturbances in bereaved caregivers. We examined the prevalence and determinants of depression and complicated grief among bereaved caregivers of patients with CVD.

METHODS

We conducted a cross-sectional survey using a self-administered questionnaire for bereaved caregivers of patients with CVD who had died in the cardiology departments of nine Japanese tertiary care centres. We assessed caregiver depression and grief using the Patient Health Questionnaire-9 (PHQ-9) and Brief Grief Questionnaire (BGQ), respectively. The questionnaire also covered caregivers' perspectives toward end-of-life care and the quality of the deceased patient's death.

RESULTS

A total of 269 bereaved caregivers (mean age: 66 (57-73) years; 37.5% male) of patients with CVD were enrolled. Overall, 13.4% of the bereaved caregivers had depression (PHQ-9 ≥10) and 14.1% had complicated grief (BGQ ≥8). Depression and complicated grief's determinants were similar (ie, spousal relationship, unpreparedness for the death, financial and decision-making burden and poor communication among medical staff). Patients and caregivers' positive attitudes toward life-prolonging treatment were associated with complicated grief. Notably, in caregivers with complicated grief, there was less discussion with physicians about end-of-life care. Caregivers who felt that the patients did not receive sufficient treatment suffered more frequently from depression and complicated grief.

CONCLUSIONS

Approximately 15% of bereaved caregivers of patients with CVD suffered from depression and complicated grief. Cardiologists should pay particular attention to caregivers with high-risk factors to identify those likely to develop depression or complicated grief.

Why listening to traumatic disclosures sometimes fails and how it can succeed

Traumatic events often launch searches for meaning, which can be advanced through emotional disclosure. Listeners contribute to reparative disclosures by attending to and accepting their content, imagery, feelings, and meanings. However, engaging in such highly attuned "authentic listening" can disrupt listeners' own fundamental beliefs. As a result, listeners can experience secondary traumatization-the intrusive images, negative emotions, and meaning searches that resemble post-traumatic stress. Listeners sometimes avoid these psychic costs by responding defensively to speakers' stories, altering their meaning, or commandeering their expression. However, listening defensively might be reduced, and authentic listening sustained by bolstering listeners' psychosocial resources. Providing listeners with their own disclosure opportunities might be a particularly potent way to do so.

An Evaluation of By My Side: Peer Support in Written Form is Acceptable and Useful for Parents Bereaved by Childhood Cancer

CONTEXT

Cancer is the leading cause of nonaccidental death in childhood, with the death of a child representing a devastating loss for families. Peer support offers a valuable way to support parents' adjustment in bereavement. The By My Side book provides written peer support by sharing bereaved parents' stories to normalize grief experiences and reduce parents' isolation. It is available free of charge.

OBJECTIVES

This project evaluated the acceptability, relevance, emotional impact, and usefulness of By My Side.

DESIGN

Bereaved parents and health care professionals (HCPs) provided feedback via a questionnaire. We used descriptive statistics and qualitative analysis of open-ended responses to analyze the data.

SETTING/PARTICIPANTS

We mailed a study invitation and evaluation questionnaire to parents and HCPs who ordered a copy of By My Side.

RESULTS

About 24 bereaved parents and seven HCPs provided feedback. Parents thought the book's length (91.7%) and amount of information (83.3%) was just right. About 75% of parents reported that the book made them feel that their reactions to their child's death were normal and/or appropriate. Parents reported positive and negative emotional reactions to the book (e.g., 87.5% felt comforted, 87.5% felt sadness). All parents and HCPs reported that the book provided useful information about grief. About 83.4% of parents and 85.7% of HCPs would recommend it to others.

CONCLUSION

By My Side was acceptable and useful to bereaved parents and HCPs. Results suggest that peer support in written form may help normalize aspects of grief and comfort parents bereaved by childhood cancer.

Thiamine deficiency in the bereaved after cancer-related spousal loss

Objective

Thiamine deficiency (TD) is recognized in various kinds of disease with associated loss of appetite including cancer. However, it has not been recognized to date in bereaved partners after spousal loss from cancer.

Method

From a series of bereaved partners who lost a spouse to cancer, we report on those who developed TD after bereavement.

Result

Case 1 was a 57-year-old woman who sought consultation at our “bereavement clinic.” Her husband had been diagnosed with pancreatic cancer one year earlier and had died one month previously. At the first visit, she was observed to suffer depression, anxiety, and decreased appetite. Neurological, blood, and biochemical examinations did not reveal any noteworthy findings. She was diagnosed with uncomplicated bereavement. Detailed examination revealed that her appetite had been markedly decreased for approximately five weeks. The diagnosis of TD was supported by her abnormally low serum thiamine level. Case 2 was a bereaved 73-year-old male who had lost his wife to hypopharyngeal cancer one month previously after a five-year illness. He had shown a lack of energy for the month preceding his wife's death, but because there was no improvement after her death, his family recommended he seek consultation at our “bereavement clinic.” He was suffering from major depressive disorder. Detailed examination revealed that his appetite had been decreased for more than two weeks. Again, the diagnosis of TD was supported by his abnormally low serum thiamine level.

Significance of results

These reports demonstrate that there is a possibility that bereaved could develop TD after the loss of a loved one. TD should be considered whenever there is a loss of appetite lasting for more than 2 weeks, and medical staff should pay careful attention to the physical condition of the bereaved to prevent complications because of TD.